Illinois Department of Public Health BRCA1 and BRCA2: Information for Illinois Health Care Professionals IIow common are BRCA1 and BRCA2 mutations? e In the general population, between one in 300 and one in 800 individuals carry a BRCA1 or 2 or mutation."' o For individuals of Ashkenazi Jewish ancestry, one in 40 individuals carry a BRCA1 or 2 mutation. What percentage of breast and ovarian cancers are caused by BRCAI or BRCA2 mutations? . 5 percent-10 percent ofall breast cancer. Up to 15 percent of ovarian can""rs.t-o What are the lifetime cancer risks associated with BRCA1 and BRCA2 mutations? o Breast cancer: 44 percent-87 percent o Ovarian cancer: 20 percent-50 percent r Male breast cancer and pancreatic cancer: -7 percent Which patients should I refer to a genetic counselor for risk assessment and discussion of genetic testing for BRCA1 and BRCA2 mutations? Patients who have a personal or famillz history (this includes maternal or paternal lineages) or those who have had:1-3'5 o Breast cancer at a young age (younger than age 50) o Ovarian cancer atany age o Bilateral breast cancer or 2 or more primary tumors of the breast r Breast and ovarian cancer o Breast cancer and are male o Two or more biological relatives* on the same side of the family with breast andlor ovarian cancer (*parent, child, siblings, grandparent, grandchild, aunVuncle, niece/nephew, first cousin) o Breast or ovarian cancer and are of Ashkenazi Jewish ancestry o Confirmed BRCAI or BRCA2 mutation in their family Specific indications for genetic counseling and testing vary among professional organizations. The indications above are to be used as a guide and are not a substitute for clinical judgment. Not all clinical scenarios can be anticipated such as when there is a limited family structure or family medical history. What are the benefits of genetic counseling when offering BRCAI and BRCA2 testing? r Patient education and informed consent are critical aspects of the genetic testing process and will help individuals decide if genetic testing is right for them. o Pre-test counseling addresses the implications of potential test results, medical management options, psychosocial challenges, laws protecting against genetic discrimination, other options for testing and testing costs. Examples include: o The possibility of false negative results because genes other thanBRCAl and2 may be responsible for cancers in the family o The possibility of test results with mutations noted to have 'ouncertain clinical significance" o The cost of BRCA gene testing differs depending on which level of testing is indicated ($440-$3,770) o The possibility of indirectly disclosing non-paternity, non-disclosed adoptions or use of egg or sperm donation o If help is needed, a genetics health care professional also can provide assistance with dissemination of relevant information to at-risk family members. Resources Genetics health care professionals: . Illinois Department of Public Health (http :/Avwry-ieltrrh.state. il. us/HealthWellness/genetics.htm) o National Society of Genetic Counselors (www.nsgc.org) o National Cancer Institute (www.cancer.gov/search/geneticsservices/) o National Center for Biotechnology Information (www.ncbi.nlm.nih.gov/sites/genetests/clinic) BRCA1 and BRCA2 refercal, testing and risk management guidelines: o American College of Obstetrics and Gynecology (ACOG) o ACOG Practice Bulletin. Obstet Gynecol. ll3(4):957-966.412009 o American Society of Clinical Oncology (ASCO) o JCO Vol 2l(12):2397-2406. 612003. o National Cancer Institute (NCD o wwrv.eaqq€rgqv'caneeftopics/pdq/genetics/breast-and-ovarian/healthprefgssional o National Comprehensive Cancer Network (NCCN) oww . U.S. Preventative Services Task Force (USPSTF) o r.yww.ahrq. gov/cUniciuspstf/uspsbrgen.htm Patient friendly facts about genetic testing for breast and ovarian cancer risk . U.S. Centers for Disease Control and Prevention o www.cdc.gov/genomics/resources/diseases/breast:ovarian_cancer.htm o Facing Our Risk of Cancer Empowered (FORCE) o www&cingourrisk.org o National Cancer Institute o www.cancer.gov/cance:topics/genetic-testing-for-brea$t-and-ovarian-cancer-rigk o National Institute of Health - Genetics Through a Primary Care Lens: A Web-Based Resource for Faculty Development o www.ggngte!.1ls.elg References i. Berliner, J.L. et al. (2001) Risk assessment and genetic counseling for hereditary breast and ovarian cancer: Recommendations of the National Society of Genetic Counselors. Journal of Genetic C ounseling. 1 6:24I-260. 2. U.S. Centers for Disease Control and Prevention. Located September 4,2009, at http://www.cdc.gov/genomics/training/perspectives/factshts/breastcancer.htm. 3. National Cancer Institute. Genetic Testingfor BRCAI and BRCA2: It's Your Choice. Located September 4,2009, at http://www.cancer.gov/canceftopicsifactsheet/Risk/BRCA/print?page:&ke).rvord 4. Pinsky, L.E., et al. (2001) Why should primary care physicians know about breast cancer genetics? Western Journal of Medicine. 17 5:168-173. 5. Guidelines listed in Resources above. IDPH Genetics Program - Phone: 217-785-8101.